Walkow T., Klemen U. M.

Augenklinik im AÖK St. Pölten, Österreich

Self-sealing incision techniques have been used in cataract surgery for several years. These techniques can also be adapted for vitreoretinal surgery. This video demonstrates techniques of no-stitch phacoemulsification with implantation of a foldable intraocular lens with the Unfolder® in the capsular bag combined with no-stitch pars plana vitrectomy in a patient with intumescent cataract and a macular hole. The sclerotomy preparation technique for pars-plana-vitrectomy is analogous to the normal tunnel technique used for the phaco. The tunnel for the self-sealing sclerotomy is prepared 4.5 mm from the limbus. This tunnel has a width of 3.5 mm and is dissected in to about one third of the scleral thickness. The length of the tunnel should be about 1.5 mm. Because the sclerotomies are self-sealing, the following vitrectomy can be performed in a closed system. Therefore intraoperative hypotony is prevented and the risk of choriodal hemorrhage is significantly reduced. An advantage of the previous cataract operation is that blood and vitreous can be removed completely up to the ora serrata. An additional advantage is the lower astigmatism postoperatively compared to conventional vitreoretinal surgery. Additional the use of trypan blue (VisionBlue®, concentration 0,6 mg/ml, D.O.R.C.) for better visualization of anterior capsule of the intumescent cataract as well as the use of Indocyanine Green (ICG-Pulsion®, concentration 1,25 mg/ml) for surgical treatment of the macular hole is shown.

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